Pharmaceutical Giant Puts Medical-Home Concept to the Test

Working with a nonprofit program, GlaxoSmithKline is giving its North Carolina employees the opportunity to test a medical home's efficiency. The pharmaceutical company will see whether the two-year pilot program could mean cost savings.

Given its focus on research, it shouldn't be surprising that GlaxoSmithKline doesn't accept a premise at face value. Instead, the London-based pharmaceutical giant wants to verify for itself that a relatively new collaborative model for providing primary care services could result in better health outcomes for employees and lower health insurance premiums for the company.

In January 2012, GlaxoSmithKline began allowing its North Carolina employees to receive primary care services through a relatively new concept known as patient-centered medical homes as part of a two-year pilot program.

The medical home concept puts patients under the care of a team of doctors, nurses and other health care professionals who are paid extra to actively manage a person's health and health care.

A patient-centered medical home puts the focus on preventive medicine and better care for chronic illnesses, says Andrew Webber, president and CEO of the National Business Coalition on Health, a not-for-profit representing more than 7,000 employers with 25 million employees and their dependents.

"With better management of chronic diseases in an ambulatory setting, we have a greater opportunity to reduce emergency room visits and hospitalizations," he says.

While hard-dollar results of the medical home program are still a bit fuzzy, more companies are showing interest.

GlaxoSmithKline, with about 60,000 U.S. employees, their dependents and retirees covered by health insurance, has seen its health care costs in the United States climb about 8 percent per year for the past decade. "We're looking to see if we can improve health and see some costs savings," says Rick DeOliveira, director of U.S. benefits for GSK.

And GSK is far from alone in seeking lower costs combined with better care. The National Survey of Employer-Sponsored Health Plans 2011 by consultancy Mercer found that in 2010, just 3 percent of companies surveyed with more than 5,000 employees had medical homes in place. Last year the total had doubled, to 6 percent, while 56 percent of those surveyed said they were interested in setting up medical homes. More than 2,800 employers of all sizes responded to the survey.

GSK decided to roll out the program in North Carolina because a tried-and-true patient-centered medical home model already is in place.

The not-for-profit Community Care of North Carolina has an established medical home program for Medicaid patients in the state, and saved Medicaid nearly $1 billion in four years. Drawing from that experience, the agency established First in Health in 2011, providing medical home services to GSK and a handful of other public and private employers.

Eric Bassett, a senior partner at Mercer, says studies have found that medical homes have improved the quality of care, but debate remains over whether they reduce health care costs.

Because medical homes thus far have primarily served Medicaid patients, a big question remains on the kind of savings that can be reaped by a private company that has many well-educated employees on staff, such as physicians and those who hold a doctorate.

"The Medicaid population is not identical to GSK professionals," DeOliveira cautions.

A medical home serves as the basis for coordinated medical care for an individual, and medical-home staff work to educate patients so they're better informed about their care. "It's back to the future," DeOliveira says. Under the model, patients "have a relationship to a primary care physician," with the emphasis on the quality of care that physicians provide, rather than on the number of patients they see.

As an example, he cites an employee with diabetes who is treated by a primary care physician at a medical home. Along with being examined by the physician, the employee might receive tips on healthy eating from the medical home's in-house nutritionist.

On the other extreme, if a patient needs care from a specialist such as a cardiologist, the details of that examination are relayed back to the primary care physician, and those findings are incorporated into future health care discussions and decisions involving the patient, DeOliveira says.

Companies pay extra for that additional attention. Along with the regular payments to health care providers, GSK pays First in Health less than $5 per medical home patient per month to provide that extra level of care.

GSK has about 5,700 employees and retirees in North Carolina, plus their dependents, who are eligible to join a medical home. So far about one-quarter have signed up. GSK estimates the per-member, per-month payment will total about $100,000 this year.

"The most valuable way to maintain health is for every person to have a doctor or group of doctors who knows your personalized case and see you regularly," says Helen Darling, CEO of the National Business Group on Health, a not-for-profit that represents more than 300 large businesses on national health policy issues.

The National Business Group on Health is a member of Washington-based Patient-Centered Primary Care Collaborative, which advocates for a strong primary care and medical home system. The collaborative's board members include leaders of such organizations as the American Academy of Pediatrics, American Academy of Family Physicians and American College of Physicians.

One GSK employee who made the switch to a medical home is Diane Mackie, director of care management liaisons. Mackie, who is based in Raleigh, left her former primary care physician for a medical home in January. "It wasn't easy to change," says Mackie, who had gone to the same doctor for a decade. But now she's glad she's made the move.

Mackie, who is a registered nurse, met with her medical home's nurse practitioner to discuss her health care goals. Mackie travels frequently for work, and has seen her weight creep up. The nurse practitioner suggested she try Weight Watchers. Since the start of the year she's lost 30 pounds, her cholesterol medication dosage has been decreased, and her asthma medication has been eliminated.

The medical home staff "seemed to be motivated differently and took a real interest in my health," Mackie says.

Switching to a medical home is voluntary, but to entice employees to try patient-centered medical homes, GSK is waiving its typical $25 copay for an office visit.

GSK wants to compare the health results of those North Carolina employees who use medical homes to the health outcomes of other GSK employees who are treated under traditional care models, DeOliveira says.

The pilot phase will run for two years, and then the results will be examined to determine whether there are differences in the level of care and the health outcomes of those who opt for a medical home, compared to a traditional health care model. GSK has set up a number of benchmarks—which haven't been disclosed to the physicians involved—to try to gauge differences in care. For example, the company might check to see if someone who has diabetes and opts for care with a medical home receives foot examinations to check for poor circulation more frequently than someone who is not part of a medical home.

That will determine whether medical homes are used in other locations where GSK has a major concentration of employees.

"Based on the results, we'll make a call—did it work, or didn't it," DeOliveira says.